Running head: HR 993: OPIOID ABUSE PREVENTION 1

Analysis of House of Representatives Bill 993: Opioid Abuse Prevention and Treatment Act of

2017

GNRS 504: Bioethics and Health Care Policy

Kanchana Allan

Azusa Pacific University

HR 993: OPIOID ABUSE PREVENTION 2

Analysis of House of Representatives Bill 993: Opioid Abuse Prevention and Treatment Act of

2017

Opioid prescribing increased three-fold in 2015 compared to 1999 (CDC, 2017b).

According to the Centers for Disease Control and Prevention (CDC), there were enough opioids

prescribed in 2015 that could have medicated every American, 24 hours per day for three weeks

(CDC, 2017b). To help combat this growing epidemic, a congressional policy was proposed on

February 9, 2017 cited as the “Opioid Abuse Prevention and Treatment Act of 2017”

(Congress.gov, 2018). The bill proposes a peer-review process to identify questionable

prescribing and dispensing practices of drugs listed as schedule II or III under the Controlled

Substances Act (Congress.gov, 2018). If restrictions are placed on prescribing and dispensing

practices, it will require changes in pain management techniques from a nursing perspective

(Pasero, Quinlan-Colwell, Broglio, & Drew, 2016). The purpose of this paper is to analyze the

proposed policy using Malone’s (2005) health policy analysis framework and identify ethical

concerns and impact to nursing and healthcare.

Background
Opioid prescribing for chronic pain such as back pain or arthritis started in the 1990s. It

is estimated that 20% of adults with non-cancer related pain are prescribed opioids by their

primary care provider (CDC, 2017a). Data has shown that those who abuse opioids the most

obtain them from friends and family or from drug dealers (CDC, 2017a). However,

approximately 85% of opioids in circulation were originally dispensed through primary care

providers (CDC, 2017a). Demographic data shows prescription use is greater in specific

individuals. These include adults 40 years and above, women (more than men), and non-

Hispanic whites (CDC, 2017a).

Prescribing practices by primary care providers has been shown to vary across the

country (Olsen, Daumit, & Ford, 2006). In a study conducted by Olsen et al (2006), physicians in
HR 993: OPIOID ABUSE PREVENTION 3

the Northwest and Southern states were more likely to prescribe opioids for chronic pain versus

those in the Midwest or the Northeast (Olsen et al, 2006). This could be explained by the more

lenient laws in the West and South. Pain laws in the 1990s protected physicians from legal

implications related to opioid prescriptions for pain as it was determined to be within their

prescribing rights. In the Northeast and Midwest, strict documentation requiring triplicate copies

of the prescription was mandated which discouraged physicians from prescribing. Another

argument can be made that states such as Washington, Oregon, and California have very

progressive views about drug treatment for pain such is the case with the legalization of

marijuana for medical purposes (Olsen et al, 2006). Olsen et al (2006) connected the results to

previous research, which has shown that physicians do not always adhere to recommended

practice guidelines for prescribing. The combination of discomfort in not treating a patient’s

pain, along with poor training, time constraints, and risk of adverse outcomes may push primary

care providers to override practice guidelines (Olsen et al, 2006).

To combat over-prescribing, many states have implemented the Prescription dDug

Monitoring Program (PDMP), an electronic system that tracks the prescription of controlled

substances within a state. The system allows health care providers to view prescribing histories

of patients. However, there are several limitations with the PDMP. Pharmacists are required to

enter prescriptions into the state’s PDMP but are not required to enter in real time. Pharmacists

submit information at daily to monthly intervals, which can lead to inaccurate prescription

tracking (CDC, 2017a). Additionally, since the system automatically tracks credit purchases,

drug abusers can pay cash to avoid being detected in the system. Also, some pharmacists do not

verify that the individual picking up the prescription is the patient. Furthermore, there is a lack of

robust data sharing across the country, which encourages drug abusers to travel to another state

to get the medication (Gabay, 2015).

HR 993: OPIOID ABUSE PREVENTION 4

House of Representatives Bill 993

Laws and policies to discourage and restrict the use of opioids have been in place in the

United States since the late 1800s (The National Alliance, 2016). The Controlled Substance Act

of 1970 was the first policy to regulate the manufacturing and distribution of various drugs

including narcotics, stimulants, hallucinogens, etc. (The National Alliance, 2016). This policy

also categorized drugs into five classes based on their potential harm, with category one being

the most dangerous. It was not until 1986 that a federal law was enacted to establish drug abuse

prevention and education strategies (The National Alliance, 2016).

The Opioid Abuse Prevention and Treatment Act of 2017 was introduced to the House of

Representatives on February 9, 2017. Congressman Bill Foster (Democrat from Illinois) is the

lead sponsor of the bill. After the policy was introduced to Congress, it was referred to the

Committee on Energy and Commerce on the same day (Congress.gov, 2018). On February 10,

2017, the bill was referred to the Subcommittee on Health. It is currently in process of review

where it has a 2% chance of passing (Govtrack.us, 2017). No documented opposition to this

proposed bill was found during research for this paper.

The purpose of this bill is to help deter the abuse and misuse of opioid drugs on schedule

II or III under the Control Substances Act and contains several proposals within. One such

proposal is the implementation of a one-year pilot program in one or more states (Congress.gov,

2018). These states will receive funding by the federal government to create a standardized

process for tracking, which will allow insight into the prescribing and dispensing practices of

primary care providers and pharmacists using the prescription drug monitoring programs

(PDMP) (Congress.gov, 2018). The evaluation of the process and methodology will be peer

reviewed and the data will be shared with relevant professional health boards as well as state

regulators (Congress.gov, 2018). Additionally, the policy includes awarding 5-year grants to

states, physician organizations, and health institutions to implement training programs for their
HR 993: OPIOID ABUSE PREVENTION 5

primary care providers (including nurse practitioners and physician’s assistants) (Congress.gov,

2018). The purpose of the training is to teach providers how to screen for patients with potential

addiction tendencies, how to provide brief interventions, and how to refer patients for treatment

as necessary to prevent drug abuse of controlled substances (Congress.gov, 2018). The bill

outlines continuing education certification for those providers who have completed training on

safe prescribing for schedule II or III drugs. Next, the policy proposes to request practitioners

and pharmacists to conduct a screening for prior drug abuse before prescribing medication

(Duke, 2017). This task will be delegated to the Department of Justice (Duke, 2017). The policy

will seek approval from the Food and Drug Administration (FDA) to allow purchase of naloxone

(used to reverse opioid overdose) as an over the counter medication (Congress.gov, 2018).

Finally, the bill proposes enforcing opioid dispensing limits for hospital emergency departments

(Congress.gov, 2018).
Policy Analysis
Congressman Foster argues that the opioid epidemic has become a public health crisis in

the United States (Foster, 2018a). He emphasizes that people need to start viewing opioid

addiction as a treatable medical condition rather than a failure attributed to the patient (Foster,

2018a). Foster emphasizes that the science behind addiction needs to be understood in order to

better address the issue (Foster, 2018a). HR 993 proposes a multi-faceted approach to fighting

the opioid epidemic from understanding prescribing patterns of primary care providers, to

screening for patients who may be predisposed to addiction, to expanding the prescription of

drugs to help treat opioid addiction and abuse (Congress.gov, 2018). This approach will require

funding to better understand pain management and to provide proper training to prescribers.
In September 2017, Foster stated that over 90 people die from heroin or opioid overdose

every day in the US. There was a 70% increase in overdose-related deaths from 2014 to 2015

(Foster, 2017). Combatting this problem requires alternatives to using opioids for pain. A
HR 993: OPIOID ABUSE PREVENTION 6

research study that won the Nobel Prize identified specific protein receptors in the brain that are

responsible for the addictive response (Foster, 2017). The National Institutes of Health (NIH)

conducted research on pain treatment, overdose prevention and dependency treatment, but

further testing is needed (Foster, 2017). However, President Trump may cut funding to the NIH

by $2 billion in his 2018 budget policy, which could severely impact this research and prevent

thousands of people from benefiting from the outcomes of that research (Foster, 2018b ). Passing

HR 993 may help to shed a spotlight on the need for further research into preventing opioid

addiction.
Ethical Discussion

If HR 993 passes, it will have a large impact on healthcare professionals and patients. In

one regard, it seems obvious that providers should restrict prescribing opioids to those patients

who may be profiled as addictive personalities or who have past history of drug abuse. It is

necessary to view the proposed bill from an ethical perspective. With the possibility of patients’

preference being put aside, autonomy is one ethical consideration to explore (Beauchamp and

Childress, 2013). The policy’s proposals could potentially withhold prescribing medication for

pain, which leaves the patient in a dire situation. Consequently, leaving a patient with untreated

pain is unethical (Bennett, 2017). Healthcare providers are obligated to advocate and protect

their patients, which leads one to also consider the importance of nonmaleficence and

beneficence (Beauchamp and Childress, 2013).

Autonomy
Beauchamp and Childress describe autonomy as “self-rule that is free from both

controlling interference by others and limitations that prevent meaningful choice, such as

inadequate understanding” (Beauchamp and Childress, 2013, pg. 101). This means allowing the

patient to decide which option is best for himself after being provided with all the necessary

information and without coercion in any particular direction. With greater scrutiny of prescribing
HR 993: OPIOID ABUSE PREVENTION 7

practices, will HR 993 deter primary care providers from prescribing opioid pain medications to

the patients that genuinely need it? Does this oppose the patient’s autonomy? Foster pushes for

greater scrutiny, through trained practitioners, to sift out those patients who have tendencies to

abuse drugs or have done so in the past. These individuals may be viewed as persons with

‘diminished autonomy’ (Beauchamp and Childress, 2013, pg. 101) as they can be viewed as

handicapped due to their altered mental status due to the influence of drugs. In this situation, the

patients may lose their right to autonomy (Beauchamp and Childress, 2013). HR 993 will review

prescribing and dispensing practices of providers and pharmacists by using an electronic

prescription drug monitoring program (PDMP) system. The policy also requires prescribers to

register with the Drug Enforcement Administration before being eligible to prescribe controlled

substances. The data from the system will be available to professional health boards and state

regulators. Fosters stance on these programs is to make prescribing opioids for patients harder in

order to protect them from overdose and addiction. However, providers may be very hesitant to

prescribe under these guidelines, fearing that they may be implicated for inappropriate

dispensing of drugs. This places providers in an authoritative position and removes the patient’s

choice from the decision-making process. It is important that respect for autonomy not be

violated with this policy. This includes ensuring that the patient is well educated regarding drug

treatment so that they understand relevant information related to their choices. If a patient’s

autonomous right is restricted, then the argument must be clear that the provider is acting to

protect the patient’s safety (Beauchamp and Childress, 2013).

Non-maleficence and Beneficence

“Above all do no harm” (Beauchamp and Childress, 2013, pg. 150). This statement,

known synonymously with the Hippocratic oath places great responsibility on healthcare

providers to protect their patients. Similarly, non-maleficence states that “One ought not to inflict
HR 993: OPIOID ABUSE PREVENTION 8

evil or harm” (Beauchamp and Childress, 2013 pg. 152). HR 993’s purpose is to protect patients

from undue risk of addiction and overdose by putting in place stricter procedures and regulations

over prescribing practices. However, if this decision puts the patient in pain, does this fall within

the constructs of non-maleficence? If the patient’s pain persists and becomes chronic, then he/she

may resort to illicit drugs to alleviate it (Bennett, 2017). Untreated pain can contribute to poor

quality of life and lead to adverse physiological and psychological issues (Bennett, 2017;

Glowaki, 2012). The bill may impact some patients by promoting prescribers to withhold

treatment of opioids, whereas others may have treatment withdrawn. There are arguments that

withdrawing treatment may be a worse alternative (Beauchamp and Childress, 2013). In the case

of HR 993, if treatment is to be withdrawn, then practitioners will be trained to implement

treatment programs for opioid withdrawal. However, this may not make the patient feel any less

anxious.
Beneficence is described as doing what is good for others (Beauchamp and Childress,

2013). It requires health care professionals to advocate, support, educate, assess and help their

patients to find a balance between controlling pain and ensuring safety (Pasero et al, 2016). The

purpose of HR 993 is to provide a benefit by helping to eliminate unnecessary complications

from the use of opioids. Just as with non-maleficence, there are two sides to this ethical

consideration. By protecting patients from using these drugs, providers are left with the issue of

untreated pain. Utility is a concept connected with beneficence. It “requires that agents balance

benefits, risks, and costs to produce the best overall results” (Beauchamp and Childress, 2013 pg.

202). In order to truly protect the patient and the patient’s best interest, a balance must be struck

on both sides of each of these ethical perspectives (Beauchamp and Childress, 2013). HR 993 is

designed to protect patients from unnecessary exposure to opioid treatment. The bill seeks to “do

no harm” and to benefit patients (Beauchamp and Childress, 2013 pg. 150) by training providers
HR 993: OPIOID ABUSE PREVENTION 9

to identify those at risk for addiction and overdose; by learning how to treat and refer patients

who are already suffering from addiction; and by implementing better tracking systems to

identify those who are attempting to obtain un-prescribed medication (Congress.gov, 2018).
Nursing and the Opioid Epidemic
Nurses are constantly faced with the dilemma of managing patients’ pain levels (Glowaki,

2012). Patient and provider education regarding pain is an important aspect in helping to control

pain. A patient’s understanding about pain is important in framing their perspective of the pain

therapy (Glowaki, 2012). A review and analysis of opioid policies at various levels of the

government was conducted by Jukiewicz, Alhofaian, Thompson, and Gary (2017). Their analysis

revealed inconsistencies across the country in prescribing behaviors, medication knowledge and

education, pain level assessment, and regulatory oversight by government agencies. The authors

felt that these all contributed to the opioid challenge faced today (2017). There are several

implications to nursing that surfaced from the authors’ analysis that resulted in several

recommendations. Nurses of all levels (but especially advanced care nurses who prescribe) need

to have a better understanding of the opioid prescribed, which includes knowing the

pathophysiology as well as the side effects and signs of addiction and overdose (Jukiewicz et al,

2017). It is critical for nurses to collaborate closely with members of the healthcare team to

communicate details regarding the patient’s pain goals, past drug history, and emotional/physical

status. The authors also recommend that nurses are provided with in-depth education regarding

opioid use and abuse (Jukiewicz et al, 2017).

Provision three of the nurse Code of ethics states, “The nurse promotes, advocates for,

and protects the rights, health, and safety of the patient,” (Fowler & American Nurses

Association [ANA], 2015, p. 23). The emphasis of this provision is to preserve and promote a

culture of safety for the patient. This includes nurse education regarding policies and procedures

at the institutional level to understand when the treatment of a patient is unsafe. Section 3.5 of
HR 993: OPIOID ABUSE PREVENTION 10

provision three talks about the nurse’s responsibility to ensure safety by identifying and exposing

questionable practice. The details within this part of the provision clearly outline the nurse’s role

in serving as a whistleblower for unethical, illegal practices that can harm the patient’s welfare

(Fowler & ANA, 2015). HR 993’s proposal intends to find areas of questionable practice through

the peer-reviewed, standardized process of exploring current prescribing and dispensing practices

(Congress.gov, 2018).
There may be times when nurses feel a conflict of interest when caring for a patient.

Provision two of the Code of ethics states “The nurse’s primary commitment is to the patient,

whether and individual, family, group, community, or population,” (Fowler & American Nurses

Association [ANA], 2015, p. 11). The obligation for nurses has been to put the needs of the

patient first, however this has changed in the context of the more paternalistic model and

Hippocratic oath to “do no harm,” (Fowler & American Nurses Association [ANA], 2015, p. 14).

In the case of opioid prescription, nurses may feel a need to advocate for their patient and

minimize their pain. As this provision states, the environment is more complex in the modern

world. Even though minimizing pain is important, choosing opioids for someone who struggles

with addiction may be putting them at greater harm (Fowler & ANA, 2015). Nurses will need to

collaborate more with physicians in order to provide the optimum level of care. Section 2.3 of

the provision discusses collaboration and the active participation that is necessary in order to

achieve this (Fowler & ANA, 2015). If HR 993 is passed, hospitals and institutions may need to

re-visit current working models to ensure this strong collaborative approach.

Personal Reflection
I support this bill in its plan to help stop a growing opioid addiction epidemic that has

killed thousands of people (Foster, 2017a). I also understand that the feeling of pain is very real

for each person. It is not for one person to judge the pain of another because God has made each

of us unique. I also agree with the recent arguments made by Foster that we should refrain from
HR 993: OPIOID ABUSE PREVENTION 11

condemning those that are addicted to opioids. We need to stop placing blame and start to look

for solutions. Opioid addiction is a disease just like any other and it is in our best interest to help

those around us to overcome. The Bible says in 1 Corinthians 10:13 13 “No temptation has

overtaken you but such as is common to man; and God is faithful, who will not allow you to

be tempted beyond what you are able, but with the temptation will provide the way of escape

also, so that you will be able to endure it,” (New American Standard Bible Version). Perhaps HR

993 is a way to help those plagued with addiction to overcome, but a lot of work is still required.

I think there should be more emphasis on alternatives to pharmacological pain treatment, such as

music therapy, guided imagery, and meditation. I would like to see this reflected in the bill. Close

collaboration between the interdisciplinary healthcare team is vital in order to have all of the data

to make a decision that will benefit the patient. This includes providing more opportunities for

nurses to immerse themselves in the pathophysiology and medical aspects of treatment. Nurses

are often the first and sometimes last line of defense for patients, which makes nurses

involvement in policy development very important (Jukiewicz et al, 2017). The opioid epidemic

is complex and requires a multi-faceted, multi-disciplinary approach (Foster, 2017a), with

nursing being one of the center pillars of influence.

Conclusion
The opioid epidemic is a growing problem in the US, killing thousands annually (Foster,

2017). However, it is also a problem that can be controlled. The proposals outlined in HR 993

can help provide the proper training and guidance for providers to understand the signs of

improper use of opioid medications (Jukiewicz et al, 2017). It will take a multi-pronged approach

using systems, training, and education in order to be effective. It is important to recognize the

need for alternatives to pharmacological pain treatment if opioid prescriptions are restricted.

Leaving patients with untreated pain is not an option. Healthcare providers are bound by an oath
HR 993: OPIOID ABUSE PREVENTION 12

to protect and advocate for their patients. HR 993 may require modification in order to ensure

that the ethical concepts of autonomy, non-maleficence, and beneficence are considered and

incorporated into the policy. HR 993 may not be the perfect solution for the opioid epidemic, but

it is a step in the right direction.

References

Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics. New York: Oxford

University Press.

Bennett, K., RN. (2017). The Opioid Epidemic and Untreated Pain: Ethical Tensions. Retrieved

April 06, 2018, from http://magazine.nursing.jhu.edu/2017/03/the-opioid-epidemic-and-

untreated-pain-ethical-tensions/

Congress.gov. (2018). Text - H.R.993 - 115th Congress (2017-2018): Opioid Abuse Prevention

and Treatment Act of 2017. [online] Available at: https://www.congress.gov/bill/115th-

congress/house-bill/993/text?q=%7B%22search%22%3A%5B%22opioid%22%5D

%7D&r=1 [Accessed 5 Apr. 2018].

Centers for Disease Control and Prevention (CDC). (2017a). Opioid Overdose. Retrieved April

05, 2018, from https://www.cdc.gov/drugoverdose/data/prescribing.html

Centers for Disease Control and Prevention (CDC), (2017b). Vital Signs. Retrieved April 05,

2018, from https://www.cdc.gov/vitalsigns/opioids/index.html

HR 993: OPIOID ABUSE PREVENTION 13

Duke Science and Society (2017). Opioid Abuse Prevention and Treatment Act of 2017 (HR 993,

115th Congress). Retrieved April 06, 2018, from http://scipol.duke.edu/content/opiod-

abuse-prevention-and-treatment-act-2017-hr-993-115th-congress

Foster, B., U.S. Congressman. (2017). Fight the opioid epidemic with science. Retrieved April

05, 2018, from https://foster.house.gov/media/in-the-news/fight-the-opioid-epidemic-

with-science

Foster, B., U.S. Congressman. (2018a). Opioid Crisis. Retrieved April 05, 2018, from

https://foster.house.gov/issues/opioid-crisis

Foster, B., U.S. Congressman. (2018b). Foster Statement on Trump Opioid Plan. Retrieved April

05, 2018, from https://foster.house.gov/media/press-releases/foster-statement-on-trump-

opioid-plan

Gabay, M., JD, BCPS. (2015). Prescription Drug Monitoring Programs. Hospital Pharmacy, 50,

277-278. Retrieved April, 2018, from http://www.thomasland.com/hpjdig/hpj5004-

277.pdf

Glowacki, D., RN, MSN, CNS, CNRN-CMC. (2015, June). Effective Pain Management and

Improvements in Patients' Outcomes and Satisfaction. Retrieved April 06, 2018, from

http://ccn.aacnjournals.org/content/35/3/33.full

Govtrack.us (2017). Opioid Abuse Prevention and Treatment Act of 2017 (H.R. 993). Retrieved

April 05, 2018, from https://www.govtrack.us/congress/bills/115/hr993

Jukiewicz, D. A., Alhofaian, A., Thompson, Z., & Gary, F. A. (2017). Reviewing opioid use,

monitoring, and legislature: Nursing perspectives. International Journal of Nursing

Sciences, 4(4), 430-436. doi:10.1016/j.ijnss.2017.09.001

Malone, R. E. (2005). Assessing the Policy Environment. Policy, Politics, & Nursing Practice,
HR 993: OPIOID ABUSE PREVENTION 14

6(2), 135-143. doi:10.1177/1527154405276141

Olsen, Y., Daumit, G. L., & Ford, D. E. (2006). Opioid Prescriptions by U.S. Primary Care

Physicians From 1992 to 2001. The Journal of Pain, 7(4), 225-235.

doi:10.1016/j.jpain.2005.11.006

Pasero, C., Quinlan-Colwell, A., Rae, D., Broglio, K., & Drew, D. (2016). American Society for

Pain Management Nursing Position Statement: Prescribing and Administering Opioid

Doses Based Solely on Pain Intensity. Pain Management Nursing, 17(3), 170-180.

doi:10.1016/j.pmn.2016.03.001

The National Alliance of Advocates for Buprenorphine Treatment. (2016). Retrieved April 06,

2018, from https://www.naabt.org/laws.cfm

HR 993: OPIOID ABUSE PREVENTION 15

Kanchana Allan
1988 Monarch Ridge Circle
El Cajon, CA 92019

April 6, 2018

Congressman Duncan Hunter

1611 Magnolia Ave #310
El Cajon, CA 92020

Dear Congressman Hunter,

I am a second degree nursing student at Azusa Pacific University. Prior to nursing school I
worked at a biotechnology company for over 26 years. I understand the importance medications
have in improving the quality of life of patients from the pharmaceutical industry and nursing
perspective. I also understand the issues we face as a nation when it comes to the use of opioids
for treatment of pain. I’m writing to thank you for your support of Congressman Foster’s HR 993
bill: “Opioid Abuse Prevention and Treatment Act of 2017”.

I believe this bill is a step in the right direction for addressing opioid abuse and addiction. The
strategies outlined in the bill will help to monitor and regulate the prescribing patterns of
providers. It will also help train and educate providers to identify those patients who may be at
greater risk for abusing their medications. In addition to what is already in the proposed bill,
there needs to be more emphasis on developing alternatives to pharmacological pain treatment,
such as the use of meditation, music therapy, or other non-medicinal pain management
interventions. Congressman Foster has outlined work initiated by the National Institutes of
Health (NIH) to do just that. I believe this research combined with HR 993’s proposals can make
a significant difference in reducing opioid abuse and potentially save thousands of lives.

As a future nurse and nurse practitioner, my commitment will be to protect and advocate for the
health and safety of my patients. This bill is aligned with that commitment. I hope you feel the
same and can help promote this bill in Congress and vote to move it forward.

Sincerely,

Kanchana Allan
HR 993: OPIOID ABUSE PREVENTION 16

Appendix

Rubric
HR 993: OPIOID ABUSE PREVENTION 17

Grading Rubric for Ethics/Policy Paper

Category Exemplary Meets Requirements Needs Improvement Points

Background Clearly identifies a current issue in nursing. Topic is identified and Topic and purpose of
Maximum Topic is introduced and defined; focus, defined. Significance and the paper is unclear.
2 points significance, and direction of the paper clear direction are identified.
to reader.
Ethics Provides an in-depth discussion of the Topic addressed Topic not addressed
Discussion ethical issues involved. adequately. adequately.
• At least 2 ethical principles • Information provides • Information provides
Maximum • 2 nursing code of ethics reader with introductory little knowledge on
4 points • Criteria that must be met for decision- knowledge of topic. topic.
making. • Organization by • Lacks organization.
• Nursing’s perspectives in the discussion. theme/issue. • Many or significant
• Cultural & faith integration perspectives • Minor problems with problems with
• Own personal values. transition and order of transition and order of
• Topic addressed in depth & thoughtful & paragraphs or sections. paragraphs or
detailed synthesis of literature • Content vocabulary sections.
• Themes and issues are clearly identified. generally accurate. • Significant errors in
• Transitions link sections and paragraphs • 1 ethical principle is content vocabulary
well. discussed. • Little insight
• Content vocabulary used appropriately • 1 nursing code of ethics demonstrated.
and well. • Minimal insight • Required components
demonstrated. absent
Health Healthcare policy is identified and clearly Healthcare policy is Healthcare policy is not
Policy described. identified, but not clearly clearly discussed.
• Policy analysis framework is identified discussed. • No policy framework
Maximum and applied • Framework is identified utilized.
2 points • Themes and issues are clearly identified. and applied. • Information provides
• Transitions link sections and paragraphs • Organization by little knowledge on
well. theme/issue. topic.
• Content vocabulary used appropriately • Minor problems with • Lacks organization.
and well. transition and order of • Many or significant
• Supporters/opponents clearly identified paragraphs or sections. problems with
• Content vocabulary transition and order of
generally accurate. paragraphs or
• Supporters/opponents not sections.
clearly identified • Significant errors in
content vocabulary
Conclusion Clear conclusions based on findings. Conclusions based on Conclusions not
Insights and inferences appropriate and well findings. connected to findings.
Maximum supported from the literature reviewed. Inferences appropriate. Inferences
2 Points inappropriate.
Letter Clear, concise, points made. Points implied, content not Missing
Max 1 points Business letter format (APA 6th ed) clear.
Assignment Addresses all required elements of Addresses all required All required elements of
Max. 2 assignment & expands them. elements of assignment. assignment not
points addressed
Grammar & No grammar or spelling errors. Coherent. 1-2 minor errors per page. 3 or more errors per
Spelling Flows well Minor problems with page. Problems with
Max. 3 coherence and flow coherence and flow
points Adjusted Turn-it-in Score < 10%
Adjusted Turn-it-in score 10 Adjusted Turn-it-in score
– 15% > 15%
APA Format All citations include all elements of APA No more than two minor More than two minor
for Citations formatting, including an intro/conclusion, errors in APA style errors or one significant
according to examples in APA 7.01. formatting in all citations. error in formatting in all
Max. 2 Adequate quality and quantity of sources Follows examples in APA citations. Does not
points used 7.01. follow APA 7.01.
Insufficient quantity and No additional sources
quality of sources used. used
*Formatting Follows all APA formatting guidelines; uses Follows all formatting Formatting errors; page
Max. 2 Word functions appropriately, includes an guidelines; minor problems length incorrect; poor
points introduction and a conclusion with Word functions. use of Word functions.